<div style="position:relative;">
	<input name="method" value = "confirm" type="hidden"/>
	Register successfull, a confirm mail had been sent to your email address. Please check and comfirm.
	<div>Email Address</div>
	<div><input type="text" name="email_address" value=""/></div>
	<div>Confirm Code</div>
	<div><input type="text" name="confirm_code"/></div>
	<button onclick="request(this.offsetParent);">Confirm</button>
</div>